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Body image and restrained eating in blind and sighted women: A preliminary study
Body Image 7 (2010) 172–175
Contents lists available at ScienceDirect
Body Image journal homepage: www.elsevier.com/locate/bodyimage
Brief research report
Body image and restrained eating in blind and sighted women: A preliminary study Eleni-Marina Ashikali *, Helga Dittmar University of Sussex, Brighton, UK
A R T I C L E I N F O
A B S T R A C T
Article history: Received 11 May 2009 Received in revised form 14 January 2010 Accepted 18 January 2010
Sociocultural theory attributes the high levels of body image concerns and disordered eating in Western women to the promotion of an unrealistically thin body ideal. This study investigated body dissatisfaction, restrained eating, and attitudes toward appearance in visually impaired and sighted women. There were 21 congenitally blind, 11 blinded later in life, and 60 sighted. Blind women were more satisfied with their body and dieted less than sighted women. Appearance attitudes, particularly thin-ideal internalization, accounted for differences in body dissatisfaction and dieting among the three groups of women. Possible explanations for our findings are considered, including the importance of visual exposure to the media’s thin ideal, as well as the usefulness of future research on blind women. ß 2010 Elsevier Ltd. All rights reserved.
Keywords: Visual impairment Congenital blindness Thin ideal Body image Eating behavior
Introduction Body dissatisfaction, ‘‘the experience of negative thoughts and esteem about one’s body’’ (Dittmar, 2008, p. 124), has become so widespread among women, that it has been described as ‘‘normative’’ (Ricciardelli & McCabe, 2004), and 95% of women are estimated to diet at least once in their life (Grogan, 2008). Sociocultural theory provides the dominant framework for understanding the development of body dissatisfaction, focusing on the unrealistically thin ‘body perfect’ ideal transmitted and reinforced by various social influences (Dittmar, 2009). Of these, the mass media are described as the ‘‘loudest and most aggressive purveyors of images . . . of ideal slender beauty’’ (Groesz, Levine, & Murnen, 2002, p. 2). If it is, indeed, visual exposure to thin-ideal media that promotes negative body image and problematic eating behavior, then we would expect to find systematic differences between women who are sighted and women who are blind. Yet, there is hardly any previous research on visual impairment and body image. In sighted women, a substantial body of research has linked the degree and type of media exposure to body dissatisfaction and problematic eating behaviors (Levine & Murnen, 2009). Two metaanalyses confirm that, exposure to thin-ideal images leads to adverse effects on women’s body image, respectively identifying an effect size of d = .31 for body satisfaction (Groesz et al., 2002), and effect sizes of d = .28 for body satisfaction and d = .30 for eating behaviors (Grabe, Ward, & Hyde, 2008). Hence, the evidence * Corresponding author at: Social and Applied Psychology Research Group, Department of Psychology, University of Sussex, Brighton BN1 9QH, UK. E-mail address: [email protected] (E.-M. Ashikali). 1740-1445/$ – see front matter ß 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.bodyim.2010.01.002
for a general deleterious thin-ideal media effect is strong, consistent with sociocultural theory. However, there is a further research strategy for examining the impact of visual media on women’s body image: to investigate visually impaired women. Thus far, research has almost invariably used sighted samples, neglecting blind women, who may well offer new insights into the visual media’s effect on women’s body image. There is only one previous study (Baker, Sivyer, & Towell, 1998), finding that congenitally blind women had the lowest levels of body dissatisfaction and restrained eating, followed by women blinded later in life, with sighted women significantly higher on both. This study provides an important first insight into visual impairment and body image, but it did not investigate women’s attitudes toward appearance, which may account for the observed group differences. A useful extension, therefore, is to investigate appearance attitudes that are known risk factors for body dissatisfaction and dieting. The degree to which appearance is central to women’s selfconcept influences the extent to which they are dissatisfied with their body (Brown & Dittmar, 2005; Hargreaves & Tiggemann, 2002). Therefore, women whose appearance is important to their self-worth may be more prone to negative body image. Awareness and internalization of the thin ideal are two further risk factors of interest. A distinction must be made between simply being aware of the sociocultural thin ideal, and actively endorsing it as a personal goal. Research making this distinction found internalization to be a more powerful correlate of body image and eating problems (Cusumano & Thompson, 2001). In fact, thin-ideal internalization has been described as the key vulnerability factor for women’s body image disturbances (Cafri, Yamamiya, Brannick, & Thompson, 2005; Thompson & Stice, 2001).
E.-M. Ashikali, H. Dittmar / Body Image 7 (2010) 172–175
The main aim of the current study is to examine differences in body dissatisfaction and restrained eating in blind and sighted women, addressing the novel question of whether these differences can be accounted for by three sets of appearance attitudes: appearance as a source of self-worth, thin-ideal awareness and thin-ideal internalization. Images that display and glamorize thin, attractive women are ubiquitous in advertising and the media (Dittmar, 2008), reinforcing the importance of being thin and attractive. As a consequence of their inability to see this imagery, blind women may accord less importance to appearance and may be less likely to internalize the thin ideal as their personal goal. It is not clear whether awareness would necessarily be lower in blind compared to sighted women, particularly not in women blinded later in life, since sociocultural ideals can be communicated through other than visual means, such as parental feedback (Pierce & Wardle, 1996). However, awareness is the first step to becoming conscious of the thin deal, thus potentially facilitating internalization. Given that women blinded later in life have had several years of visual exposure to media ideals, whereas those congenitally blind had none, group differences were expected to appear in a linear fashion: congenitally blind women were predicted to be lowest on all variables, followed by women blinded later in life, and sighted women highest: 1. Blind women will report less body dissatisfaction and restrained eating than sighted women. 2. Compared to sighted women, blind women will rely less on appearance as a source of self-worth (ASW), internalize the thin ideal to a lesser extent, and possibly be less aware of the thin ideal. 3. One or more of the selected risk factors (ASW, awareness, internalization) will account for group differences in body dissatisfaction and restrained eating.
173
age as a covariate and country as the factor (F(1,84) < 2.61, ns). The mean age was 27.12 years (SD = 5.97, range = 18–40), and the mean body mass index was 21.22 (SD = 1.83, range = 16.2–25.65). The three groups differed in age (F(2, 89) = 10.36; p < .001), but not in self-esteem (F(2, 89) = .86, p = .73), or BMI (F(2, 89) = 1.71, p = .18). Therefore, age was controlled for in subsequent analyses. Materials Body dissatisfaction was measured using an abridged 8-item scale of the Body Shape Questionnaire (BSQ; Cooper, Taylor, Cooper, & Fairburn, 1987), and restrained eating using the 10-item subscale of the Dutch Eating Behavior Questionnaire (DEBQ; Van Strien, Frijters, Bergers, & Defares, 1986). The extent to which women gain self-worth from their appearance was measured by the appearance subscale from Contingencies of Self-Worth (ASW; Luhtanen, Luhtanen, Cooper, & Bouvrette, 2003). Thin-ideal awareness and internalization were measured using four items from their respective subscales in the Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ-3: Thompson, Van den Berg, Roehrig, Guarda, & Heinberg, 2003). Items were rephrased so that they were appropriate for both blind and sighted women. All scales showed satisfactory reliabilities: BSQ (a = .92); DEBQ-R (a = .92); ASW (a = .79); awareness (a = .83); internalization (a = .80). Procedure and ethical issues
Method
Blind participants from England and Switzerland completed the questionnaire via email using text-to speech ‘‘screen readers’’, whereas those from Cyprus did so either face-to-face, or by phone. Sighted participants received the questionnaire in paper-andpencil form. The study received ethical approval from the Sussex University Ethics Committee and was conducted according to BPS/ APA ethical guidelines.
Participants
Results
Ninety-two women were recruited: 21 congenitally blind, 11 blinded later in life, and 60 sighted. Four women blinded at or before the age of 2 were classified as congenitally blind. Women blinded later in life showed great variability in length of blindness (range 16.22–97.5% of their life). To recruit blind women, the first author’s pre-existing contacts in the UK, Switzerland, and Cyprus were used. We did not expect systematic country differences in the constructs measured, which was confirmed by a MANCOVA using
Differences between groups of women ANCOVAs, with the level of visual impairment (congenital, later in life, sighted) as the independent variable, and age as covariate, were carried out on all study variables. We selected polynomial trend analyses as the most appropriate and direct test of our hypothesis that group differences follow a linear pattern. All findings are shown in Table 1.
Table 1 Body image and eating in blind and sighted women: means (standard errors) and group difference statistics. Congenitally blind
F (2, 88)
Body dissatisfaction (BD) and restrained eating (RE) BD 1.73a (0.22) 2.02a (0.31) RE 2.36a (0.20) 2.38a (0.28)
2.92b (0.13) 2.85b (0.12)
11.17*** 2.76(*)
0.80 0.52
0.26 0.02
.20 .06
.86*** .35*
Risk factors ASW Awareness Internalization
3.95b (0.13) 4.01b (0.11) 4.33b (0.13)
12.18*** 4.90** 15.80***
0.18 0.13 0.36
1.17 0.63 0.89
.22 .10 .26
.83*** .49** 1.01***
2.69a (0.12) 2.70a (0.11)
2.99(*) 0.94
0.62 0.37
0.35 0.47
.07 .02
.21 .06
4.16b (0.31) 3.89by (0.27) 3.92b (0.31)
BD and RE with risk factors controlled 1.99b (0.27) BD 2.39ab (0.21) RE 2.79a (0.20) 2.37a (0.25)
d for mean diff. sighted/blind later
Note. abDifferent superscripts indicate significantly different means. cPartial eta2. dContrast estimates. y This mean differs only marginally from the mean for congenitally blind women. *** p < .001. ** p < .01. * p < .05. (*) p < .07.
d for mean diff. congenital/later
Effect sizec
Linear trendd
Sighted
2.77a (0.22) 3.32a (0.19) 2.90a (0.22)
Blinded later
Quad. trendd .25 .19 .66* .18 .25
.46 .31
174
E.-M. Ashikali, H. Dittmar / Body Image 7 (2010) 172–175
Body dissatisfaction and restrained eating There was a significant group effect for body dissatisfaction. The linear trend was significant, indicating that as women’s extent of sightedness increases, so does dissatisfaction with their body. With respect to restrained eating, the main effect fell short of conventional significance levels (p < .07), but the linear trend, again, was significant. This suggests that as the length of time during which women are able to see increases, so does the extent to which they engage in chronic dieting. Sighted women felt significantly more dissatisfied with their body and restrained their eating significantly more than blind women, but the differences among the two blind groups did not reach significance. Overall, the first hypothesis was supported. Risk factors The group effect for appearance as a source of self-worth was significant, as were the linear and quadratic trends. The linear trend findings indicate an overall increase in the importance placed on appearance with longer duration of the ability to see. It must, however, be noted that the quadratic trend results reflect that congenitally blind women placed much less importance on appearance than the other groups, where women blinded later in life scored slightly higher than sighted women. The contrasts showed that sighted women were significantly higher on ASW than blind women, but the difference between the two blind groups did not reach significance. Thin-ideal awareness and internalization showed similar patterns with significant group effects and significant linear trends. Sighted women were significantly more aware of, and endorsed the thin ideal as a personal goal significantly more, than congenitally blind women, but not more than those blinded later in life. Thus, second hypothesis was partially supported. Risk factors, body dissatisfaction and restrained eating In order to examine whether the putative risk factors explain the group differences in body dissatisfaction and restrained eating, two further ANCOVAs were carried out, with age and risk factors as covariates. If the risk factors do account for group differences, we would expect both group effects and linear trends to be reduced to non-significance. Taking the risk factors into account, both the group effect (F(2, 88) = 2.99, p = .06) and linear trend (CE = .21, p = .25) were indeed reduced to non-significance for body dissatisfaction. The only risk factor to show a unique significant link was thin-ideal internalization (F(2, 88) = 22.66, p < .001). Thus, the extent to which women internalize the thin-ideal emerges as the primary risk factor that accounts for differences in body dissatisfaction between sighted and blind women, not awareness (F(2, 88) = .03, p = .86), nor ASW (F(2, 88) = 1.17, p = .28). In terms of restrained eating, controlling for risk factors again reduced both the group effect (F(2, 88) = .94, p = .39), and linear trend (CE = .06, p = .72) to non-significance. Here, both thin-ideal awareness (F(2, 88) = 7.94, p < .01) and internalization (F(2, 88) = 6.87, p < .01) showed significant unique links. Thus, it is the extent to which women are aware of, and internalize, the thin ideal which accounts for the previously found differences in restrained eating between sighted and blind women, but not ASW (F(2, 88) = .02, p = .88). Thus, the third hypothesis was fully supported: attitudes towards the thin ideal account for observed differences in body dissatisfaction and dieting between blind and sighted women. Discussion Exposure to the thin ideal promoted by the media has been linked to women’s high levels of body dissatisfaction and
disordered eating. Although ample research exists on media exposure and women’s body image, research has typically studied sighted samples, neglecting the potentially fruitful insights that blind women can provide for understanding the media–body relationship. The current study examined the effect of visual media exposure on women’s body image and restrained eating through comparing visually impaired with sighted women. In addition, it examined the role of three appearance attitude risk factors: appearance as a source of self-worth, thin-ideal awareness, and internalization. This is the first study to examine whether differences between blind and sighted women in negative body image and maladaptive eating behavior can be explained through differences in appearance attitudes. Consistent with the only previous study on visual impairment (Baker et al., 1998), and in support of our first hypothesis, blind women reported significantly lower levels of body dissatisfaction and restrained eating than those sighted, consistent with the notion that visual media have powerful effects on women’s body image. Extending this previous study, blind women were also significantly lower on all risk factors, supporting our second hypothesis. This suggests that their inability to see reduces the extent to which women are aware of and endorse the thin ideal, as well as the degree of importance they attach to appearance for their self-worth. Given that visually impaired women are subject to social influences from peers, family (Pierce & Wardle, 1996), and non-visual media, these findings are consistent with the idea that visual media promote the internalization of the thin ideal. However, group differences in the ability to visualize, or to compare with other women, could also play an important role for how women experience their bodies. Furthermore, the importance of appearance may pale in significance compared to other challenges in a blind person’s life. Future studies could therefore address how concerned blind women are with their appearance using qualitative methods. Our third hypothesis, that appearance attitudes would account for differences among the three groups, was supported in terms of internalization and awareness of the thin body ideal. Thin-ideal internalization was the only construct to show a significant unique link to body dissatisfaction, whereas both awareness and internalization were significantly linked to restrained eating. Thus, differences in body dissatisfaction and dieting between blind and sighted women appear to occur through endorsing different appearance attitudes, supporting the identification of thin-ideal internalization as ‘‘a causal risk factor for body image and eating disturbances’’ (Thompson & Stice, 2001, p. 181). The hypothesis that there is a linear increase in body dissatisfaction, restrained eating, and risk factors consistent with extent of visual media exposure – from congenitally blind women, to women blinded later in life, to sighted women – was supported. In the case of ASW, this overall trend was qualified, where congenitally blind women scored much lower than those blinded later in life, who score slightly higher than sighted women. Significant differences among the two blind groups emerged in terms of thin-ideal awareness and internalization, but not the other constructs. This lack of significant differences may be due, in part, to the small sample sizes of blind women; a power analysis (Cohen, 1988) suggested that in order to detect significant differences in body dissatisfaction and restrained eating between the blind groups, a sample size of about 100 participants per group would be needed. It is also worth noting that there was great variability in the length of blindness in women blinded later in life. To investigate the link between thin-ideal salience and length of blindness further, future studies may wish to make more finely grained comparison within a larger sample of women blinded later in life. A further limitation of the current study is administration differences: online and paper-and-pencil questionnaire, face-to-
E.-M. Ashikali, H. Dittmar / Body Image 7 (2010) 172–175
face and phone interviews. In order to exclude any possibility of social desirability effects, future studies should aim to use the same data collection methods for all groups of women. Given the significant differences in thin-ideal awareness and internalization among congenitally blind women and those blinded later in life, it appears that some years of media exposure are sufficient for women to become aware of, and endorse, sociocultural ideals as part of their personal belief system. This extends past findings, and is consistent with evidence that these constructs are promoted through visual media (Grabe et al., 2008). Future research involving this under-examined sample may wish to extend and substantiate further, the current correlational study through experimental means, whereby, for example, sighted and blind women receive an appearance threat such as overhearing a negative comment about their appearance, followed by measurements of body dissatisfaction. Taken together, the findings of the current study provide support for the importance of exposure to visual depictions of the thin ideal. In terms of applied implications, it adds to calls for policy changes so that media images represent a variety of body shapes, and portray a more realistic image of today’s female figure. On an individual level, girls and women need not only critical awareness of visual media, but also help in reducing the extent to which they endorse the thin ideal as an indicator of what they should look like. Acknowledgements We would like to thank all the women who took time to participate in the study, as well as the blind institutions which offered their help (UK: Royal National Blind College, Blatchington Court Trust; Switzerland: National Federation for the Blind; Cyprus: School for the Blind). Also, a big thank you to the Ashikalis, particularly to Anna for her endless support and input throughout the years and during this project. References Baker, D., Sivyer, R., & Towell, T. (1998). Body image dissatisfaction and eating attitudes in visually impaired women. International Journal of Eating Disorders, 24, 319–322.
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Brown, A., & Dittmar, H. (2005). Think ‘thin’ and feel bad: The role of appearance schema activation, attention level, and thin-ideal internalisation for young women’s responses to ultra-thin media ideals. Journal of Social and Clinical Psychology, 24, 1088–1113. Cafri, G, Yamamiya, Y., Brannick, M., & Thompson, J. K. (2005). The influence of sociocultural factors on body image: A meta-analysis. Clinical Psychology: Science and Practice, 12, 421–433. Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Hillsdale, NJ: Lawrence Erlbaum Associates. Cooper, P., Taylor, M., Cooper, Z., & Fairburn, C. (1987). The development and validation of the Body Shape Questionnaire. International Journal of Eating Disorders, 6, 485–494. Cusumano, D. L., & Thompson, J. K. (2001). Media influence and body image in 8–11 year old boys and girls: A preliminary report on the Multidimensional Media Influence Scale. International Journal of Eating Disorders, 29, 37–44. Dittmar, H. (2008). Consumer culture, identity and well-being: The search for the material good life and body perfect. In R. Brown (Ed.), European monograph in social psychology. East Sussex: Psychology Press. Dittmar, H. (2009). How do ‘‘body perfect’’ ideals in the media have a negative impact on body image and behaviors? Factors and processes related to self and identity. Journal of Social and Clinical Psychology, 28, 1–8. Grabe, S., Ward, L. M., & Hyde, J. S. (2008). The role of the media in body image concerns among women: A meta-analysis of experimental and correlational studies. Psychological Bulletin, 134, 460–476. Groesz, L. M., Levine, M. P., & Murnen, S. K. (2002). The effect of experimental presentation of media images on body satisfaction: A meta-analytic review. International Journal of Eating Disorders, 31, 1–16. Grogan, S. (2008). Body image: Understanding body dissatisfaction in men, women and children (2nd edition). London: Routledge. Hargreaves, D. A., & Tiggemann, M. (2002). The role of appearance schematicity in the development of adolescent body dissatisfaction. Cognitive Therapy and Research, 26, 691–700. Levine, M. P., & Murnen, S. K. (2009). Everybody knows that mass media are/are not [pick one] a cause of eating disorders’’: A critical review of evidence for a causal link between media, negative body image, and disordered eating in females. Journal of Social and Clinical Psychology, 28, 9–42. Luhtanen, J. C, Luhtanen, R. K., Cooper, M. L., & Bouvrette, A. (2003). Contingencies of self-worth in college students: Theory and measurement. Journal of Personality and Social Psychology, 85, 894–908. Pierce, J. W., & Wardle, J. (1996). Body size, parental appraisal, and self-esteem in blind children. Journal of Child Psychology and Psychiatry, 37, 205–212. Ricciardelli, L. A, & McCabe, M. P. (2004). A biopsychosocial model of disordered eating and the pursuit of muscularity in adolescent boys. Psychological Bulletin, 130, 179–205. Thompson, J. K., & Stice, E. (2001). Thin-ideal internalization: Mounting evidence for a new risk factor for body-image disturbance and eating pathology. Current Directions in Psychological Science, 10, 181–183. Thompson, J. K., Van den Berg, P., Roehrig, M., Guarda, A. S., & Heinberg, L. J. (2003). The Sociocultural Attitudes towards Appearance Scale (SATAQ-3): Development and validation. International Journal of Eating Disorders, 35, 293–304. Van Strien, T., Frijters, J. E. R., Bergers, G. P. A., & Defares, P. B. (1986). The Dutch Eating Behavior Questionnaire (DEBQ) for assessment of restrained, emotional, and external eating behavior. International Journal of Eating Disorders, 5, 295–315.
Contents lists available at ScienceDirect
Body Image journal homepage: www.elsevier.com/locate/bodyimage
Brief research report
Body image and restrained eating in blind and sighted women: A preliminary study Eleni-Marina Ashikali *, Helga Dittmar University of Sussex, Brighton, UK
A R T I C L E I N F O
A B S T R A C T
Article history: Received 11 May 2009 Received in revised form 14 January 2010 Accepted 18 January 2010
Sociocultural theory attributes the high levels of body image concerns and disordered eating in Western women to the promotion of an unrealistically thin body ideal. This study investigated body dissatisfaction, restrained eating, and attitudes toward appearance in visually impaired and sighted women. There were 21 congenitally blind, 11 blinded later in life, and 60 sighted. Blind women were more satisfied with their body and dieted less than sighted women. Appearance attitudes, particularly thin-ideal internalization, accounted for differences in body dissatisfaction and dieting among the three groups of women. Possible explanations for our findings are considered, including the importance of visual exposure to the media’s thin ideal, as well as the usefulness of future research on blind women. ß 2010 Elsevier Ltd. All rights reserved.
Keywords: Visual impairment Congenital blindness Thin ideal Body image Eating behavior
Introduction Body dissatisfaction, ‘‘the experience of negative thoughts and esteem about one’s body’’ (Dittmar, 2008, p. 124), has become so widespread among women, that it has been described as ‘‘normative’’ (Ricciardelli & McCabe, 2004), and 95% of women are estimated to diet at least once in their life (Grogan, 2008). Sociocultural theory provides the dominant framework for understanding the development of body dissatisfaction, focusing on the unrealistically thin ‘body perfect’ ideal transmitted and reinforced by various social influences (Dittmar, 2009). Of these, the mass media are described as the ‘‘loudest and most aggressive purveyors of images . . . of ideal slender beauty’’ (Groesz, Levine, & Murnen, 2002, p. 2). If it is, indeed, visual exposure to thin-ideal media that promotes negative body image and problematic eating behavior, then we would expect to find systematic differences between women who are sighted and women who are blind. Yet, there is hardly any previous research on visual impairment and body image. In sighted women, a substantial body of research has linked the degree and type of media exposure to body dissatisfaction and problematic eating behaviors (Levine & Murnen, 2009). Two metaanalyses confirm that, exposure to thin-ideal images leads to adverse effects on women’s body image, respectively identifying an effect size of d = .31 for body satisfaction (Groesz et al., 2002), and effect sizes of d = .28 for body satisfaction and d = .30 for eating behaviors (Grabe, Ward, & Hyde, 2008). Hence, the evidence * Corresponding author at: Social and Applied Psychology Research Group, Department of Psychology, University of Sussex, Brighton BN1 9QH, UK. E-mail address: [email protected] (E.-M. Ashikali). 1740-1445/$ – see front matter ß 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.bodyim.2010.01.002
for a general deleterious thin-ideal media effect is strong, consistent with sociocultural theory. However, there is a further research strategy for examining the impact of visual media on women’s body image: to investigate visually impaired women. Thus far, research has almost invariably used sighted samples, neglecting blind women, who may well offer new insights into the visual media’s effect on women’s body image. There is only one previous study (Baker, Sivyer, & Towell, 1998), finding that congenitally blind women had the lowest levels of body dissatisfaction and restrained eating, followed by women blinded later in life, with sighted women significantly higher on both. This study provides an important first insight into visual impairment and body image, but it did not investigate women’s attitudes toward appearance, which may account for the observed group differences. A useful extension, therefore, is to investigate appearance attitudes that are known risk factors for body dissatisfaction and dieting. The degree to which appearance is central to women’s selfconcept influences the extent to which they are dissatisfied with their body (Brown & Dittmar, 2005; Hargreaves & Tiggemann, 2002). Therefore, women whose appearance is important to their self-worth may be more prone to negative body image. Awareness and internalization of the thin ideal are two further risk factors of interest. A distinction must be made between simply being aware of the sociocultural thin ideal, and actively endorsing it as a personal goal. Research making this distinction found internalization to be a more powerful correlate of body image and eating problems (Cusumano & Thompson, 2001). In fact, thin-ideal internalization has been described as the key vulnerability factor for women’s body image disturbances (Cafri, Yamamiya, Brannick, & Thompson, 2005; Thompson & Stice, 2001).
E.-M. Ashikali, H. Dittmar / Body Image 7 (2010) 172–175
The main aim of the current study is to examine differences in body dissatisfaction and restrained eating in blind and sighted women, addressing the novel question of whether these differences can be accounted for by three sets of appearance attitudes: appearance as a source of self-worth, thin-ideal awareness and thin-ideal internalization. Images that display and glamorize thin, attractive women are ubiquitous in advertising and the media (Dittmar, 2008), reinforcing the importance of being thin and attractive. As a consequence of their inability to see this imagery, blind women may accord less importance to appearance and may be less likely to internalize the thin ideal as their personal goal. It is not clear whether awareness would necessarily be lower in blind compared to sighted women, particularly not in women blinded later in life, since sociocultural ideals can be communicated through other than visual means, such as parental feedback (Pierce & Wardle, 1996). However, awareness is the first step to becoming conscious of the thin deal, thus potentially facilitating internalization. Given that women blinded later in life have had several years of visual exposure to media ideals, whereas those congenitally blind had none, group differences were expected to appear in a linear fashion: congenitally blind women were predicted to be lowest on all variables, followed by women blinded later in life, and sighted women highest: 1. Blind women will report less body dissatisfaction and restrained eating than sighted women. 2. Compared to sighted women, blind women will rely less on appearance as a source of self-worth (ASW), internalize the thin ideal to a lesser extent, and possibly be less aware of the thin ideal. 3. One or more of the selected risk factors (ASW, awareness, internalization) will account for group differences in body dissatisfaction and restrained eating.
173
age as a covariate and country as the factor (F(1,84) < 2.61, ns). The mean age was 27.12 years (SD = 5.97, range = 18–40), and the mean body mass index was 21.22 (SD = 1.83, range = 16.2–25.65). The three groups differed in age (F(2, 89) = 10.36; p < .001), but not in self-esteem (F(2, 89) = .86, p = .73), or BMI (F(2, 89) = 1.71, p = .18). Therefore, age was controlled for in subsequent analyses. Materials Body dissatisfaction was measured using an abridged 8-item scale of the Body Shape Questionnaire (BSQ; Cooper, Taylor, Cooper, & Fairburn, 1987), and restrained eating using the 10-item subscale of the Dutch Eating Behavior Questionnaire (DEBQ; Van Strien, Frijters, Bergers, & Defares, 1986). The extent to which women gain self-worth from their appearance was measured by the appearance subscale from Contingencies of Self-Worth (ASW; Luhtanen, Luhtanen, Cooper, & Bouvrette, 2003). Thin-ideal awareness and internalization were measured using four items from their respective subscales in the Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ-3: Thompson, Van den Berg, Roehrig, Guarda, & Heinberg, 2003). Items were rephrased so that they were appropriate for both blind and sighted women. All scales showed satisfactory reliabilities: BSQ (a = .92); DEBQ-R (a = .92); ASW (a = .79); awareness (a = .83); internalization (a = .80). Procedure and ethical issues
Method
Blind participants from England and Switzerland completed the questionnaire via email using text-to speech ‘‘screen readers’’, whereas those from Cyprus did so either face-to-face, or by phone. Sighted participants received the questionnaire in paper-andpencil form. The study received ethical approval from the Sussex University Ethics Committee and was conducted according to BPS/ APA ethical guidelines.
Participants
Results
Ninety-two women were recruited: 21 congenitally blind, 11 blinded later in life, and 60 sighted. Four women blinded at or before the age of 2 were classified as congenitally blind. Women blinded later in life showed great variability in length of blindness (range 16.22–97.5% of their life). To recruit blind women, the first author’s pre-existing contacts in the UK, Switzerland, and Cyprus were used. We did not expect systematic country differences in the constructs measured, which was confirmed by a MANCOVA using
Differences between groups of women ANCOVAs, with the level of visual impairment (congenital, later in life, sighted) as the independent variable, and age as covariate, were carried out on all study variables. We selected polynomial trend analyses as the most appropriate and direct test of our hypothesis that group differences follow a linear pattern. All findings are shown in Table 1.
Table 1 Body image and eating in blind and sighted women: means (standard errors) and group difference statistics. Congenitally blind
F (2, 88)
Body dissatisfaction (BD) and restrained eating (RE) BD 1.73a (0.22) 2.02a (0.31) RE 2.36a (0.20) 2.38a (0.28)
2.92b (0.13) 2.85b (0.12)
11.17*** 2.76(*)
0.80 0.52
0.26 0.02
.20 .06
.86*** .35*
Risk factors ASW Awareness Internalization
3.95b (0.13) 4.01b (0.11) 4.33b (0.13)
12.18*** 4.90** 15.80***
0.18 0.13 0.36
1.17 0.63 0.89
.22 .10 .26
.83*** .49** 1.01***
2.69a (0.12) 2.70a (0.11)
2.99(*) 0.94
0.62 0.37
0.35 0.47
.07 .02
.21 .06
4.16b (0.31) 3.89by (0.27) 3.92b (0.31)
BD and RE with risk factors controlled 1.99b (0.27) BD 2.39ab (0.21) RE 2.79a (0.20) 2.37a (0.25)
d for mean diff. sighted/blind later
Note. abDifferent superscripts indicate significantly different means. cPartial eta2. dContrast estimates. y This mean differs only marginally from the mean for congenitally blind women. *** p < .001. ** p < .01. * p < .05. (*) p < .07.
d for mean diff. congenital/later
Effect sizec
Linear trendd
Sighted
2.77a (0.22) 3.32a (0.19) 2.90a (0.22)
Blinded later
Quad. trendd .25 .19 .66* .18 .25
.46 .31
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Body dissatisfaction and restrained eating There was a significant group effect for body dissatisfaction. The linear trend was significant, indicating that as women’s extent of sightedness increases, so does dissatisfaction with their body. With respect to restrained eating, the main effect fell short of conventional significance levels (p < .07), but the linear trend, again, was significant. This suggests that as the length of time during which women are able to see increases, so does the extent to which they engage in chronic dieting. Sighted women felt significantly more dissatisfied with their body and restrained their eating significantly more than blind women, but the differences among the two blind groups did not reach significance. Overall, the first hypothesis was supported. Risk factors The group effect for appearance as a source of self-worth was significant, as were the linear and quadratic trends. The linear trend findings indicate an overall increase in the importance placed on appearance with longer duration of the ability to see. It must, however, be noted that the quadratic trend results reflect that congenitally blind women placed much less importance on appearance than the other groups, where women blinded later in life scored slightly higher than sighted women. The contrasts showed that sighted women were significantly higher on ASW than blind women, but the difference between the two blind groups did not reach significance. Thin-ideal awareness and internalization showed similar patterns with significant group effects and significant linear trends. Sighted women were significantly more aware of, and endorsed the thin ideal as a personal goal significantly more, than congenitally blind women, but not more than those blinded later in life. Thus, second hypothesis was partially supported. Risk factors, body dissatisfaction and restrained eating In order to examine whether the putative risk factors explain the group differences in body dissatisfaction and restrained eating, two further ANCOVAs were carried out, with age and risk factors as covariates. If the risk factors do account for group differences, we would expect both group effects and linear trends to be reduced to non-significance. Taking the risk factors into account, both the group effect (F(2, 88) = 2.99, p = .06) and linear trend (CE = .21, p = .25) were indeed reduced to non-significance for body dissatisfaction. The only risk factor to show a unique significant link was thin-ideal internalization (F(2, 88) = 22.66, p < .001). Thus, the extent to which women internalize the thin-ideal emerges as the primary risk factor that accounts for differences in body dissatisfaction between sighted and blind women, not awareness (F(2, 88) = .03, p = .86), nor ASW (F(2, 88) = 1.17, p = .28). In terms of restrained eating, controlling for risk factors again reduced both the group effect (F(2, 88) = .94, p = .39), and linear trend (CE = .06, p = .72) to non-significance. Here, both thin-ideal awareness (F(2, 88) = 7.94, p < .01) and internalization (F(2, 88) = 6.87, p < .01) showed significant unique links. Thus, it is the extent to which women are aware of, and internalize, the thin ideal which accounts for the previously found differences in restrained eating between sighted and blind women, but not ASW (F(2, 88) = .02, p = .88). Thus, the third hypothesis was fully supported: attitudes towards the thin ideal account for observed differences in body dissatisfaction and dieting between blind and sighted women. Discussion Exposure to the thin ideal promoted by the media has been linked to women’s high levels of body dissatisfaction and
disordered eating. Although ample research exists on media exposure and women’s body image, research has typically studied sighted samples, neglecting the potentially fruitful insights that blind women can provide for understanding the media–body relationship. The current study examined the effect of visual media exposure on women’s body image and restrained eating through comparing visually impaired with sighted women. In addition, it examined the role of three appearance attitude risk factors: appearance as a source of self-worth, thin-ideal awareness, and internalization. This is the first study to examine whether differences between blind and sighted women in negative body image and maladaptive eating behavior can be explained through differences in appearance attitudes. Consistent with the only previous study on visual impairment (Baker et al., 1998), and in support of our first hypothesis, blind women reported significantly lower levels of body dissatisfaction and restrained eating than those sighted, consistent with the notion that visual media have powerful effects on women’s body image. Extending this previous study, blind women were also significantly lower on all risk factors, supporting our second hypothesis. This suggests that their inability to see reduces the extent to which women are aware of and endorse the thin ideal, as well as the degree of importance they attach to appearance for their self-worth. Given that visually impaired women are subject to social influences from peers, family (Pierce & Wardle, 1996), and non-visual media, these findings are consistent with the idea that visual media promote the internalization of the thin ideal. However, group differences in the ability to visualize, or to compare with other women, could also play an important role for how women experience their bodies. Furthermore, the importance of appearance may pale in significance compared to other challenges in a blind person’s life. Future studies could therefore address how concerned blind women are with their appearance using qualitative methods. Our third hypothesis, that appearance attitudes would account for differences among the three groups, was supported in terms of internalization and awareness of the thin body ideal. Thin-ideal internalization was the only construct to show a significant unique link to body dissatisfaction, whereas both awareness and internalization were significantly linked to restrained eating. Thus, differences in body dissatisfaction and dieting between blind and sighted women appear to occur through endorsing different appearance attitudes, supporting the identification of thin-ideal internalization as ‘‘a causal risk factor for body image and eating disturbances’’ (Thompson & Stice, 2001, p. 181). The hypothesis that there is a linear increase in body dissatisfaction, restrained eating, and risk factors consistent with extent of visual media exposure – from congenitally blind women, to women blinded later in life, to sighted women – was supported. In the case of ASW, this overall trend was qualified, where congenitally blind women scored much lower than those blinded later in life, who score slightly higher than sighted women. Significant differences among the two blind groups emerged in terms of thin-ideal awareness and internalization, but not the other constructs. This lack of significant differences may be due, in part, to the small sample sizes of blind women; a power analysis (Cohen, 1988) suggested that in order to detect significant differences in body dissatisfaction and restrained eating between the blind groups, a sample size of about 100 participants per group would be needed. It is also worth noting that there was great variability in the length of blindness in women blinded later in life. To investigate the link between thin-ideal salience and length of blindness further, future studies may wish to make more finely grained comparison within a larger sample of women blinded later in life. A further limitation of the current study is administration differences: online and paper-and-pencil questionnaire, face-to-
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face and phone interviews. In order to exclude any possibility of social desirability effects, future studies should aim to use the same data collection methods for all groups of women. Given the significant differences in thin-ideal awareness and internalization among congenitally blind women and those blinded later in life, it appears that some years of media exposure are sufficient for women to become aware of, and endorse, sociocultural ideals as part of their personal belief system. This extends past findings, and is consistent with evidence that these constructs are promoted through visual media (Grabe et al., 2008). Future research involving this under-examined sample may wish to extend and substantiate further, the current correlational study through experimental means, whereby, for example, sighted and blind women receive an appearance threat such as overhearing a negative comment about their appearance, followed by measurements of body dissatisfaction. Taken together, the findings of the current study provide support for the importance of exposure to visual depictions of the thin ideal. In terms of applied implications, it adds to calls for policy changes so that media images represent a variety of body shapes, and portray a more realistic image of today’s female figure. On an individual level, girls and women need not only critical awareness of visual media, but also help in reducing the extent to which they endorse the thin ideal as an indicator of what they should look like. Acknowledgements We would like to thank all the women who took time to participate in the study, as well as the blind institutions which offered their help (UK: Royal National Blind College, Blatchington Court Trust; Switzerland: National Federation for the Blind; Cyprus: School for the Blind). Also, a big thank you to the Ashikalis, particularly to Anna for her endless support and input throughout the years and during this project. References Baker, D., Sivyer, R., & Towell, T. (1998). Body image dissatisfaction and eating attitudes in visually impaired women. International Journal of Eating Disorders, 24, 319–322.
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